Cocaine Use: Recommendations in Treatment and Rehabilitation

2. Historical Overview of Cocaine Use

Cocaine is obtained from the leaves of the coca plant, which is indigenous to South America. Reports of its use date back to 3000 B.C., and its use by the Incas in Peru was commented on by the 16^th century Spanish Conquistadors (Fleming et al., 1990; Warner, 1993). The Conquistadors reported that chewing the coca leaf increased stamina, and reduced hunger and thirst. Chewing the coca leaf was the predominant method for deriving cocaine-related effects, until 1855 when the drug was isolated as an alkaloid by Albert Niemann, who named it "cocaine". Operating in an unregulated environment in the late 19^th century in both Canada and the United States, this new drug was adapted for a variety of purposes such as in teas and cigarettes, as a local anaesthetic, and in cough syrups and other remedies. It is perhaps most infamously known as an ingredient in Coca Cola. The large number of cocaine products and the ability of doctors, pharmacists and vendors to provide them to the public are blamed for the creation of a large North American drug-dependent cohort in the late 19^th century (Das, 1993; Jonnes, 1995; Smart, 1991; Warner, 1993). In Canada, cocaine was also widely used in the late 19th century, until the introduction of legislation in 1905.

Following the introduction of legislation in North America, cocaine use appeared to be confined to small subcultures for many years. Indeed, Jonnes (1995) argues that use declined most significantly this century in the United States (and presumably in Canada) around World War II, when the majority of those who had become dependent on cocaine during the 19^th century had passed away. However, reports of greater cocaine use surfaced in the 1970s, although cost impeded widespread use until the 1980s, when cocaine became popular once again, particularly with the advent of less costly "crack cocaine" (Das, 1993; Smart, 1991). Although Canadian data are not available, U.S. data strongly suggest that cocaine use is more widespread today than in the 19^th century. Examining U.S. cocaine imports from 1900 and comparing them to estimates of cocaine consumption in 1993, Das (1993) found a tenfold increase, yet the U.S. population had only increased about three times. Although its use is most prevalent in North America and Latin America, its use is also increasing in Western Europe and Australia, and is spreading to some African and Asian countries (World Health Organization, 1998).

While specific numbers are not available, historians have generally found that cocaine users in the 19^th century do not fit the profile of today's users (Das, 1993; Jonnes, 1995). There are differences in the gender distribution and social class of chronic users. Females and members of the upper class were more highly represented in the 19^th century (Jonnes, 1995). In contrast, people using cocaine today are more likely to be males, and more chronic users originate from lower income groups (McKenzie and Single, 1997).